This is resubmission under PA-11-194 (formerly PA-10-060), Mentored Patient-Oriented Research Career Development Award (Parent K23), titled Mentored Research on Improving Alcohol Brief Interventions in Medical Settings. Candidate The candidate is a clinical psychologist and promising junior-level patient-oriented researcher focused on developing, testing, and implementing brief alcohol interventions in medical settings. My education, clinical, and research experiences have provided me with a strong knowledge base of counseling approaches and quantitative RCT methodology. My short-term career goals, which would be realized with award of this K23 proposal, involve expanding my to include mixed-methods Stage 1 treatment development research and increase understanding of medical culture and research. This would allow me to translate my background of behavioral research into medical settings, where researchers who are well versed in both evidence-based counseling strategies and the unique implementation issues faced in medical settings are desperately needed. With training and mentored research experience in these areas, I would be able to make a successful transition to independence and be a competitive applicant for NIH R01 funding. It is my long-term career objective to make a significant and sustained public health impact through the rigorous study of behavioral interventions for alcohol misuse and other risky behaviors and the development of empirically validated treatment fidelity instrumentation and training, dissemination, and implementation practices. Environment My environment at the University of Virginia, Department of Psychiatry and Neurobehavioral Sciences is ideal for conducting this K23 award. The University of Virginia School of Medicine has a well-established research environment that supports high quality patient-oriented clinical research in addictions and is internationally recognized for its commitment to the development of early career investigators. I am a member of the Division of Neurobiological Studies, a faculty group focused on addiction research and home to the Center for Addiction Research and Education (CARE). Our division has over 15 NIH-funded faculty members researching addictions using genetic, biological, pharmacological, animal model, and behavioral strategies. The center is rich with interdisciplinary collaboration and translational research opportunities and is committed to the development of junior faculty. My primary mentor is Dr. Ingersoll who has a long track record of mentoring young researchers to the point of independence. We have already demonstrated our potential for productive collaboration through our work on her NIH funded grants, coauthoring papers, and her support in the development of this K23 application. In addition, the rest of my mentorship team, including Drs. Saitz, Velasquez, and Lum will further promote my learning environment through regular consultation and opportunities to conduct participatory observation visits to their respective research programs. In addition to the institutional support that I will receive in the Department of Psychiatry and Neurobehavioral Sciences, I work with closely with the Department of General Medicine and University Medical Associates (UMA) to conduct the research aims of this project. Dr. Nadkarni, who is an advisor on this project and the Medical Director of UMA has been closely involved in the development of current proposal and is highly committed to both the study aims and my development as an independent patient-oriented researcher. Research Improvements in the efficacy and efficiency of brief interventions for risky alcohol use in medical settings are needed. High levels of heterogeneity and poor internal validity of controlled trials merit the use of mixed- methods treatment development research to identify the active components or mechanisms of action of brief interventions and the development of a clearly defined, empirically generated brief intervention. Motivational interviewing (MI) is a counseling approach that is commonly integrated into brief interventions, however, little is know about which MI components might drive effectiveness and merit the extensive time and resources required for training and implementation. I propose a mixed methods study in 2 phases, the primary aims of which are 1) systematically evaluate the impact of MI behaviors and interaction techniques on a standard PI protocol, and 2) use this information to pilot test an empirically informed BI with resident interventionists. The acceptability of the tested interventions to patients will also be evaluated and mechanisms of action analyses will be conducted with audio-recorded brief interventions from both studies. Lastly, changes in resident provider BI knowledge, attitudes, and behavior will be evaluated. The proposed research, along with my training plan, will contribute to my training goals of gaining mixed-methods Stage I research skills and experience in medical culture and research. PUBLIC HEALTH RELEVANCE: This project will systematically evaluate the impact of brief intervention components on risky drinking behavior among primary care patients and use this information to develop and pilot test an empirically informed brief intervention. This study holds the promise to improve treatment effectiveness for the nation's more than 16 million risky drinkers. Lessons learned could hasten the development of brief interventions for other chronic diseases in the U.S.